The Uninsured: Where they Live and Why it Matters

With just 60 days left to sign up for health insurance under the Affordable Care Act, enrollment numbers are still lagging and the White House is increasing its efforts to spread the word about the fast-approaching deadline.

But a new study from the Associated Press suggests that tapping into certain areas in the country could help boost coverage numbers.

The AP reports that the uninsured aren’t scattered across the country—they instead live in 116 of the country’s 3,143 counties. What’s more, half of the uninsured Americans ages 19-39 live in 108 counties. Young adults are key to the success of the president’s signature legislation because they will help balance out insurance pools and keep costs in check. The government wants 7 million people enrolled by the end of the year, with 2.7 million being young and healthy people. As of the end of January, 3 million people had enrolled in plans via state and federal exchanges—with 750,000 between the ages of 18 and 34, according to the Department of Health and Human Services.

The report suggests that a targeted approach in these areas could help bring the administration closer to its original goals. The AP study was conducted by the State Health Access Data Assistance Center at the University of Minnesota, and claims to be in line with the Obama Administration’s own geographical studies.

However, a report on Tuesday from the nonpartisan Congressional Budget Office says the number of enrollees for 2014 will likely be 1 million short of the administration’s projections, at 6 million enrollees in year one.

According to the AP report, the top areas with the highest uninsured individuals areDallas, Houston, Miami, Atlanta, northern New Jersey and Philadelphia. In the Midwest, Detroit Cleveland and Indianapolis are the top three areas with residents that lack coverage. And in the south, the AP identifies Nashville and Charlotte, N.C. as areas that need focus as the enrollment period draws to a close.

Under the ACA, every individual in the country has to have insurance by the end of open enrollment period on April 1 or they will face a fine of $95 a year or 1% of their annual income for failing to comply.

Yevgeniy Feyman, Manhattan Institute scholar, says the rural areas of the country shouldn’t be overlooked as many people in these regions likely also lack coverage, despite their numbers being smaller.

“It makes sense that in the inner cities and metropolitan areas they have a large number of people to begin with so the places with the greatest amount of people will have the highest levels of uninsured,” Feyman says.

He points out that Los Angeles County is home to 5% of the uninsured nationwide.

The report will make outreach easier, but Feyman says concentrating on younger uninsured people is the most important for the administration at this point in the game.

“They have just been less successful at getting young people enrolled, and they have a lower rate of being insured,” Feyman says. “[The administration] has a high barrier to surpass in getting young and healthy people in as they need more convincing as to why they should go and buy health insurance.”